Evaluation of Serum Chromium, Nickel, and Magnesium Levels in Patients With Type 2 Diabetes Mellitus and Periodontitis: A Cross-Sectional Study

Detailed Description

Periodontal diseases are chronic immunoinflammatory conditions initiated by the interaction between the microbial dental plaque biofilm and the host immune response, leading to progressive destruction of the alveolar bone and connective tissues. Although traditionally considered localized oral infections, increasing evidence indicates that periodontitis has significant systemic implications. A well-established bidirectional relationship exists between periodontitis and type 2 diabetes mellitus (T2DM), with periodontitis being recognized as the sixth complication of diabetes. Both conditions are characterized by elevated proinflammatory cytokines and mediators, which may mutually exacerbate disease severity and progression.

Chromium (Cr) is an essential trace element involved in carbohydrate and lipid metabolism and plays a key role in insulin signaling by enhancing insulin receptor activity through its interaction with chromodulin. Chromium deficiency has been proposed as a potential risk factor for the development of diabetes, and chromium supplementation has been reported to improve glycemic control in some individuals with T2DM. Although limited studies suggest alterations in salivary chromium levels in patients with chronic periodontitis, possibly due to periodontal tissue breakdown or metal release from restorative materials, the association between periodontal disease and serum chromium levels has not been directly investigated to date.

Magnesium (Mg) is a vital mineral acting as a cofactor for more than 300 enzymatic reactions and is essential for energy metabolism, oxidative phosphorylation, and membrane integrity. Reduced serum magnesium levels are commonly observed in individuals with T2DM, and magnesium deficiency has been associated with impaired glucose-insulin metabolism and enhanced inflammatory responses. Experimental and clinical studies suggest that magnesium deficiency may aggravate periodontal inflammation and negatively affect periodontal tissue healing; however, studies evaluating magnesium status in individuals with concomitant T2DM and chronic periodontitis are limited.

Nickel (Ni) is a widely distributed environmental heavy metal, and human exposure occurs through air, water, food, tobacco products, dental materials, and metal alloys. Evidence regarding the association between nickel exposure and diabetes is inconsistent, with some studies reporting no association and others suggesting an increased risk of diabetes with higher nickel exposure. To date, no studies have directly evaluated the relationship between periodontal disease and serum nickel levels.